Provider Demographics
NPI:1659642569
Name:ROBERTS, ELAINA NICOLE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ELAINA
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BAIRSFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7002
Mailing Address - Country:US
Mailing Address - Phone:330-707-5111
Mailing Address - Fax:
Practice Address - Street 1:2001 BAIRSFORD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7002
Practice Address - Country:US
Practice Address - Phone:330-707-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147639164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse